Intrathecal Baclofen in Cerebral Palsy Movement Disorders

1996 ◽  
Vol 11 (1_suppl) ◽  
pp. S29-S35 ◽  
Author(s):  
A. Leland Albright
Keyword(s):  
Cerebral Palsy ◽  
Intrathecal Baclofen ◽  
Intrathecal Catheter ◽  
Chronic Infusion ◽  
Upper And Lower Extremities ◽  
Generalized Dystonia ◽  
Oral Doses ◽  
Screening Trial ◽  
Communication Disability

Intrathecal baclofen reduces spasticity in individuals with cerebral palsy. Intrathecal doses are far lower than oral doses and the effects are considerably greater, and the side effects are fewer. Response to intrathecal baclofen must be confirmed by a screening trial before implantation of a pump for chronic infusion. Intrathecal baclofen reduces spasticity in the upper and lower extremities and is often associated with improved gait and upper extremity function. Quality of life improves for patients and caregivers. The Medtronic pump has been exceedingly reliable and typically functions for 4 or 5 years. The currently available intrathecal catheter is associated with far fewer complications than the initial catheter. Baclofen overdoses are unusual and are usually caused by pump programming errors rather than pump malfunction. Preliminary studies suggest that continuous intrathecal baclofen infusion reduces generalized dystonia in cerebral palsy. Screening to determine response of dystonia to intrathecal baclofen is by continuous infusion. The doses required to reduce dystonia are higher than those for cerebral spasticity. Additional investigations are underway to quantify the effects of continuous intrathecal baclofen infusion on communication, disability, and dystonia. (J Child Neurol 1996;11(Suppl 1): S29-S35).

Infusion of intrathecal baclofen for generalized dystonia in cerebral palsy

1998 ◽  
Vol 88 (1) ◽  
pp. 73-76 ◽  
Author(s):  
A. Leland Albright ◽  
Margaret J. Barry ◽  
Michael J. Painter ◽  
Barbara Shultz
Keyword(s):  
Cerebral Palsy ◽  
Intrathecal Baclofen ◽  
Term Therapy ◽  
Short Term ◽  
Intrathecal Catheter ◽  
Content Type ◽  
Body Regions ◽  
Before And After ◽  
Generalized Dystonia ◽  
Fine Print

Generalized dystonia occurs in 15 to 25% of persons with cerebral palsy (CP) and responds poorly to medical and surgical treatments. Object. After the authors observed a woman whose dystonic CP was dramatically improved by continuous infusion of intrathecal baclofen, they designed this pilot study to evaluate the effect of this treatment on a group of patients with dystonic CP. Methods. The authors assessed the short-term response to intrathecal baclofen infusion in 12 patients with dystonic CP. An intrathecal catheter was inserted percutaneously and connected to an external microinfusion pump. The infusion began at a rate of 100 µg/day and was increased by 50 µg every 12 hours until the dystonia abated, adverse effects occurred, or the dose reached 900 mg/day with no improvement. Two observers, one blinded and one not blinded to the patient's treatment status, viewed videotapes made before and after the infusions and graded the dystonia in eight body regions, using a 5-point scale. Overall and regional scores were compared by using Wilcoxon signed-rank tests. Conclusions. Dystonia diminished in 10 of 12 patients whose average daily dose of intrathecal baclofen was 575 µg. Overall dystonia scores and scores for the extremities, trunk, and cervical regions were significantly better after infusion (p = 0.003). The two observers' scores were not significantly different. Programmable infusion pumps were subsequently implanted in eight patients for long-term therapy and improvement was sustained in six (p < 0.05). Intrathecal baclofen infusion is a promising treatment option for generalized dystonia associated with CP. The effects of intrathecal baclofen infusion on dystonia can be evaluated by using short-term continuous infusions.

Long-term therapy with intrathecal baclofen improves quality of life in children with severe spastic cerebral palsy

2017 ◽  
Vol 21 (3) ◽  
pp. 565-569 ◽  
Author(s):  
Tanja Kraus ◽  
Kathrin Gegenleitner ◽  
Martin Svehlik ◽  
Michael Novak ◽  
Gerhardt Steinwender ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cerebral Palsy ◽  
Intrathecal Baclofen ◽  
Spastic Cerebral Palsy ◽  
Term Therapy ◽  
Long Term Therapy

scholarly journals An Introduction to Trialing Intrathecal Baclofen in Patients with Hemiparetic Spasticity: A Description of 3 Cases

2011 ◽  
Vol 5;14 (5;9) ◽  
pp. 483-489 ◽  
Author(s):  
Michael E. Harned
Keyword(s):  
Multiple Sclerosis ◽  
Traumatic Brain Injury ◽  
Upper Extremity ◽  
Lower Extremities ◽  
Intrathecal Baclofen ◽  
Single Shot ◽  
Intrathecal Catheter ◽  
Severe Spasticity ◽  
Upper And Lower Extremities ◽  
The Right

Background: Intrathecal baclofen has been an effective therapy in the management of spasticity. As interventional pain physicians are rapidly becoming the experts in intrathecal drug delivery, they are now frequently asked to trial and implant intrathecal baclofen therapy. While some physicians might be very comfortable with the process of trialing and implanting, others will have next to no experience until the first consult appears on their desks. While uncomplicated lower extremity spasticity can usually be trialed with a single-shot bolus injection, more complicated cases of upper and lower extremities or hemiparetic spasticity need a more delicate approach. This is the first case series in the literature reporting a trial using an indwelling temporary catheter and inpatient admission. Moreover, while the technical aspects of intrathecal therapy trialing and implantation might be familiar for the interventional physician, we review the indications and goals of therapy, about which the physician may be less familiar. Objective: To present a technique for trialing intrathecal baclofen in patients with severe upper and lower extremities spasticity complication for which a single shot technique may be inadequate. Design: Case report of three patients. Setting: Tertiary-care referral medical center. Patients: A 30-year-old man with severe spasticity of the right upper and lower extremities with preserved left-sided function due to diffuse axonal injury. A 45-year-old woman with traumatic brain injury and severe spasticity of the left upper extremity with minimal dysfunction in the right upper extremity. A 34-year-old woman with Multiple Sclerosis and severe spasticity in the right upper extremity and bilateral lower extremities. Intervention: Placement of a temporary intrathecal catheter and an inpatient trial of intrathecal baclofen. Results: In all patients, there was significant improvement in spasticity as documented by decreased Modified Ashworth Scale scores while preserving motor strength and coordination in the unaffected extremities. Limitations: Retrospective review of 3 cases in a single center. Conclusions: Trialing for baclofen is usually performed as a single shot bolus. For patients with severe hemiparetic spasticity or in patients where weakness in the unaffected limb might significantly affect quality of life, this trialing technique may be inadequate. In these patients, placement of a temporary intrathecal catheter and inpatient admission may be a more effective trial method. Key words: Baclofen, intrathecal drug delivery, spasticity, multiple sclerosis, traumatic brain injury

scholarly journals Neglected femoral neck fractures in cerebral palsy: a narrative review

2020 ◽  
Vol 5 (1) ◽  
pp. 58-64
Author(s):  
Giuseppe Toro ◽  
Antimo Moretti ◽  
Marco Paoletta ◽  
Annalisa De Cicco ◽  
Adriano Braile ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Femoral Neck ◽  
Motor Function ◽  
Treatment Options ◽  
High Morbidity ◽  
Fibular Graft ◽  
Motor Impairments ◽  
High Prevalence ◽  
Neck Fracture

Hip fractures are severe conditions with a high morbidity and mortality, especially when the diagnosis is delayed, and if formulated over 30 days after the injury, is termed a ‘neglected femoral neck fracture’ (NFNF). Cerebral palsy (CP) is probably one of the major risk factors for NFNF in Western countries, mainly because of both cognitive and motor impairments. However, considering the high prevalence of fractures in these patients, the incidence of NFNF in this population is probably underestimated, and this condition might result in persistent hip or abdominal pain. Several techniques are available for the treatment of NFNF (i.e. muscle pedicle bone graft, fixation with fibular graft, valgisation osteotomy), but most of them could affect motor function. Motor function must be preserved for as long as possible, in order to enhance the quality of life of CP patients. After discussing published NFNF cases in CP patients and available treatment options, a practical approach is proposed to facilitate the orthopaedic surgeon to both early identify and appropriately manage these challenging fractures. Cite this article: EFORT Open Rev 2020;5:58-64. DOI: 10.1302/2058-5241.5.190019

scholarly journals Determinants of participation and quality of life of young adults with cerebral palsy: longitudinal approach and comparison with the general population – SPARCLE 3 study protocol

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Catherine Arnaud ◽  
Carine Duffaut ◽  
Jérôme Fauconnier ◽  
Silke Schmidt ◽  
Kate Himmelmann ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Young Adults ◽  
Cerebral Palsy ◽  
Young People ◽  
General Population ◽  
Transition Period ◽  
Well Being ◽  
Personal Factors ◽  
The Impact

Abstract Background Effective inclusion in society for young people with disabilities is increasingly seen as generating opportunities for self-development, and improving well-being. However, significant barriers remain in the vast majority of activities meaningful for young adults. Research argues that various personal (disabilities, health) and environmental (access to the resources needed, accessible environment, discrimination, lack of personal economic independence) factors contribute to limited participation. However, previous studies conducted in young people with cerebral palsy (CP) mainly investigated the transition period to adulthood, and did not fully consider the whole range of impairment severity profiles or environmental barriers. In this study, we will use the follow-up of the SPARCLE cohort and a comparison group from the general population (1) to investigate the impact of the environment on participation and quality of life of young adults with CP, (2) to determine predictors of a successful young adulthood in educational, professional, health and social fields, (3) to compare quality of life and frequency of participation in social, work and recreational activities with the general population, (4) to document on participation and quality of life in those with severe disabilities. Methods The SPARCLE3 study has a combined longitudinal and cross-sectional design. Young adults with CP aged 22 to 27 years in 6 European regions previously enrolled in the SPARCLE cohort or newly recruited will be invited to self-complete a comprehensive set of questionnaires exploring participation (daily life and discretionary activities), health-related quality of life, body function, personal factors (health, personal resources), and contextual factors (availability of needed environmental items, family environment, services provision) during home visits supervised by trained researchers. Proxy-reports or adapted questionnaires will be used for those with the most severe impairments. The recruitment of a large group from the general population (online survey) will enable to identify life areas where the discrepancies between young people with CP and their able-bodied peers are the most significant. Discussion This study will help identify to what extent disabilities and barriers in environment negatively affect participation and quality of life, and how previous valued experiences during childhood or adolescence might modulate these effects.

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